My mother-in-law, 84 years of age, suffers from incontinence as
the result of a stroke. She has had a Foley catheter in place for
about a year now. The catheter is irrigated regularly. But, it
seems the catheter is plugging up more frequently than in the
beginning and is having to be changed more frequently.
It appears that part of the problem may be a large amount of mucous
in her urine.
I have some specific questions. (1) is there any effecitve way to
reduce the amount of mucous? (2) Does collapse of the bladder walls
contribute to this problem? (3)Would insertion of a suprapublic
catheter alleviate this problem?
Any advise Would be greatly appreciated.

Dear Dan,
Urinary incontinence in an elderly stroke victim is a difficult problem. Ideally no chronic indwelling catheter would be used. These are associated with urinary tract infection, bladder stone formation, hematuria (blood in the urine), erosion of the urethra, contraction of the bladder, and renal failure. If the patient cannot urinate and has overflow incontinence, then clean intermittant catheterization is the safe and effective choice. Urge incontinence after stroke can sometimes be treated with medications that relax the bladder. Stress incontinence (unrelated to the stroke) has a variety of other treatments.
As a last resort a chronic indwelling foley urethral catheter is used. It should be changed at least once a month. The patient should be encouraged to increase their fluid intake to flush things (including "mucous") through. The catheter should be changed if signs of infection are present. In women a suprapubic catheter has no marked advantages in this setting (the patient may still leak from below, have infections, form stones, contract the bladder, and develop renal failure).
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
* Keyword: Chronic indwelling foley catheter

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